Stress and Acne

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It’s finals week and you’re tired, anxious, and stressed out about all those tests, including that daunting organic chemistry exam. Ever notice that your complexion seems to be stressing out right along with you, erupting in more pimples or acne cysts?

It’s probably not just your imagination, says Lisa A. Garner, MD, FAAD, a clinical professor of dermatology at the University of Texas Southwestern Medical Center. "When you already have acne and you get into a stressful situation, that seems to be when your acne really flares up.”

In other words, emotional stress won’t trigger a new case of acne, but it may worsen matters in someone who already has the skin disorder.

Stress and Acne: Is There a Connection?

For a long time, doctors have suspected that stress worsens acne, but evidence was mostly anecdotal. In the past decade, though, research has suggested that the doctors may be on the right track.

In 2003, a Stanford University study published in the Archives of Dermatology found that college students had acne flare-ups during exams, a period in which they reported more stress, compared to periods without testing. Acne severity correlated highly with increasing stress, the researchers concluded.

Still, scientists don’t know exactly how stress worsens acne. They do know that cells that produce sebum have receptors for stress hormones, according to Garner. Sebum is the oily substance that mixes with dead skin cells and bacteria to clog the hair follicles, leading to a pimple or acne cyst.

When a person with acne experiences a lot of stress, "somehow, they’re upregulated," Garner says of the sebum-producing cells. This means that more oil is produced to clog the hair follicles to allow more acne to form -- and give the stressed individual more to pick at.

But it’s only a clue, and the actual mechanism remains elusive. In a 2007 study of high school students in Singapore, researchers from Wake Forest University School of Medicine also found that acne worsened during exam times, compared to low-stress periods, such as summer break. The study was published in a Swedish medical journal, Acta Derm Venereol.

These researchers hypothesized that the increase in acne might be due to higher levels of sebum produced during stressful times. However, they found that psychological stress didn’t increase sebum production significantly in the teens, leading them to suggest that that acne linked to stress may involve other root causes.

When Stress Makes You Mess With Your Skin

Sometimes, stress and acne can interact in a harmful cycle. When some people are anxious or upset, they’re more likely to exacerbate their blemishes, Garner says. "Some people pick their skin when they’re stressed. If they have a pimple to pick, that’s where they’re going."

What Is Acne Excoriee?

While many people squeeze a pimple occasionally, Garner sees more extreme cases in which patients pick at their blemishes compulsively because they’re worried and embarrassed about their skin. "Every little thing that shows up on a person’s skin -- every small pimple -- they pick it. They can’t make themselves stop."

This condition is called acne excoriee. When these patients see Garner, ''they literally don’t have a pimple in existence," she says. Instead, they have scabs that can lead to scarring. "Those patients can actually turn very mild acne into terrible scars."

Garner treats their acne. If their skin clears up, "there’s nothing to pick," she says.

Sometimes, she can convince patients to stop picking, but if not, she might refer them for psychological help, she says.

To prevent scarring, "It’s really important that people do not pick and squeeze their pimples," Garner says.

Treating Acne

What can be done? A person can’t really use stress reduction as an acne treatment, Garner says.

For many people, acne is a chronic problem that doesn’t just vanish after finals week. It’s often a long-term issue that requires acne treatment, which can include benzoyl peroxide, retinoids, antibiotics applied to the skin or taken by mouth, hormonal treatments, and in more difficult cases, isotretinoin (Accutane).

That said, people with acne can also take advantage of seeing a psychologist or learning biofeedback if they need to reduce high levels of stress overall, Garner says.